Online adaptive radiotherapy for prostate cancer: Current evidence and clinical perspectives

Adaptive radiotherapy has emerged as a promising strategy to improve the precision of prostate cancer treatment by accounting for daily anatomical variations. Recent technological advances have enabled online treatment adaptation, particularly in the context of magnetic resonance-guided radiotherapy. This review summarizes the current evidence on adaptive radiotherapy for prostate cancer, focusing on dosimetric data and clinical outcomes in the upfront, reirradiation and post-prostatectomy settings. While dosimetric studies support improved target coverage and reduced violations of organ-at-risk dose constraints with adaptive radiotherapy, the clinical translation of these benefits remains unclear. Early clinical data suggest favourable toxicity profiles, especially with magnetic resonance-guided stereotactic body radiotherapy, although most available evidence derives from non-randomized studies with limited follow-up. Further prospective studies are required to establish the true clinical value of adaptive workflows and to define their role in the routine management of prostate cancer.